New Coronavirus News from 13 Dec 2021

Omicron is spreading fast. That's alarming even if it's mild [CNN, 13 Dec 2021]

By Maggie Fox

(CNN)The Omicron variant of coronavirus is spreading quickly in several countries where it has been discovered. Even if it causes only mild disease -- and that's far from certain -- that could still mean many people end up in the hospital and dying.

It's killed at least one person in the UK and put 10 into the hospital -- most of them vaccinated, according to government authorities.

"It is spreading faster than the Delta variant in South Africa where Delta circulation was low, but also appears to spread more quickly than the Delta variant in other countries where the incidence of Delta is high, such as in the United Kingdom," the World Health Organization said in a technical briefing last week.

"Given the current available data, it is likely that Omicron will outpace the Delta variant where community transmission occurs," WHO added.

It's not clear how severe the new variant is, although most cases that have been diagnosed so far have been mild. That could be reassuring, but if Omicron spreads more easily than Delta and previous variants, evades the protection offered by vaccines and by previous infection, and ends up infecting more people, that could mean more people end up in the hospital and more die.

"What we now know about Omicron is that ... it's spreading at a phenomenal rate, something that we've never seen before. It's doubling every two to three days in infections," UK Health Secretary Sajid Javic told Britain's Sky News Monday. "That means we're facing a tidal wave of infection. We're once again in a race between the vaccine and the virus."

A new study out Monday from researchers at Oxford University adds to evidence that two of the main vaccines deployed against Covid-19 -- the AstraZeneca vaccine used widely in Britain and around the world but not in the US,and the Pfizer/BioNTech vaccine used widely in the US, Europe and elsewhere -- won't protect people as well against the Omicron variant.

"Our findings show that vaccine effectiveness against symptomatic disease with the Omicron variant is significantly lower than with the Delta variant," the researchers wrote.

Infecting both the vaccinated and the boosted
Several reports indicate at least some of those infected with Omicron have been both fully vaccinated and boosted, and tests against blood samples from vaccinated and boosted people indicate the same thing.

What this may indicate is that vaccination and especially booster shots provide good protection against severe disease with the Omicron variant, doctors say -- although it is far too soon to know for sure. Health officials note many of the first cases have been seen among travelers and people who might be in good health and who might take other precautions.

Disease modelers at the London School of Hygiene and Tropical Medicine released a report Saturday that projects infections in England passing last winter's peak in terms of daily numbers. This could translate into double the number of daily hospital admissions as seen last year, they wrote in a pre-print report posted online.

What's really uncertain is what Omicron will do to more vulnerable people, who are unlikely to be among the first infected, but who will eventually see the virus come their way. This might include the elderly, people with varying levels of immune compromise and those with pre-existing medical conditions.

Seeking out the susceptible
"This virus will eventually seek out and land on the people who are the most susceptible, and those are the ones that have not been vaccinated, A, and also the ones that have not been boosted. It's not a matter of if. It's a matter of when," Los Angeles internal medicine specialist Dr. Jorge Rodriguez told CNN.

"High numbers can still mean many people in the hospital," Dr. Crystal Watson, a senior associate at the Johns Hopkins Center for Health Security, told CNN.

While only a few cases have been identified in the US so far, there is little reason to think it will not spread in the US as it has elsewhere.

Houston officials said last week the Omicron variant had been detected in wastewater there, although it had not yet turned up in tests of people diagnosed with the virus. That could indicate quiet community spread -- something that would not be surprising for a variant that causes mild symptoms or no symptoms. WFTV reported similar findings in central Florida but quoted Altamonte Springs city manager Frank Martz as saying detecting any genetic material from the virus indicated more than one person in the area was infected with the variant.

Even without Omicron adding to the spread, the Delta variant combined with an undervaccinated population, is doing plenty of damage.

The US passed 50 million reported cased of coronavirus infection Monday, and is fast approaching 800,000 deaths.

The CEOs of several health care systems in Minnesota signed a full-page newspaper ad begging people to get vaccinated.

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"Our emergency departments are overfilled, and we have patients in every bed in our hospitals," the ad read. "Your access to health care is being seriously threatened by COVID-19. We need to stop the spread!"

It urges people to get vaccinated and boosted, to wear masks and to get tested for the virus.

California Orders New Universal Indoor Mask Mandate, Effective Wednesday, As Infection Rates Rise [Deadline, 13Dec 2021]

By Tom Tapp

In a surprise move Monday, California state officials announced that the state is instituting a universal indoor mask mandate, effective Wednesday, December 15. The current mandate will run through January 15, 2022.

“We will require universal masking in indoor settings statewide,” said state director of health and human services Dr. Mark Ghaly, noting that the order will cover the roughly 50% of California’s population not currently under such a mandate.

“We know people are tired and hungry for normalcy. Frankly, I am too,” Ghaly admitted today. “That said, this is a critical time where we have a tool that we know has worked. We are proactively putting this tool of universal indoor masking in public settings in place to ensure we get through a time of joy and hope without a darker cloud of concern and despair.”

The state will also tighten restrictions on unvaccinated people who attend indoor “mega-events” of 1,000 people or more, requiring them to receive a negative Covid test within one day of the event if it’s a rapid antigen test or within two days for a PCR test. Current rules require a test within 72 hours of the event.

The state is also recommending, but not requiring, that people who travel to California or return to the state after traveling be tested for Covid within three to five days.

Current state guidelines — which are followed by many counties including Riverside, Orange and San Diego — say masks are only required indoors at public transit facilities such as airports, healthcare settings, adult and senior care facilities, schools, correctional facilities, homeless shelters, emergency shelters and cooling centers. The new order extends the requirement in those counties to movie theaters, retail stores, restaurants, family entertainment centers and government offices that serve the public.

Los Angeles County already has a mask-wearing mandate at indoor public facilities.

The state currently requires mask-wearing for unvaccinated people at indoor public facilities, but the new rule will apply to everyone regardless of vaccine status.

Ghaly noted on a hastily-arranged conference call with reporters that the state had seen a 47% rise in case rates since Thanksgiving, from 9.6 per 100,000 cases to 14 per 100,000. He also reported that local hospitals are seeing patient levels “significantly above their baseline for this time of year.”

He continued: “We know that we’re entering into a pretty hard time, that we’re staring to see some of these numbers come up pretty quickly in some communities…[Masking] is the common sense thing to do.”

Infections are not spread evenly across the state, he said. “There are some counties that are well above our average (in case rates).” That could mean “serious challenges” to those communities, according to Ghaly. Many of those communities are also among the least vaccinated.

He pointed to rising infections in Riverside and San Bernardino, Inyo and Mono Counties and the Central Valley, as well as in the northernmost parts of the state, such as Humboldt, Del Norte and Mendocino.

Last winter, the state saw about 28,000 deaths related to Covid between November 2020 and February 2021. The HHS director said officials are hoping to avoid a repeat of that tragedy.
“Frankly with Delta and Omicron and the more rapid replication, we are seeing people who — if they do become severely sick — they are becoming sicker sooner. So we don’t have nearly as much room…as we did last year to make adjustments.”

While Delta still dominates, the state has identified 13 instances of the Omicron variant, including some that appear to be via community transmission — as opposed to those people who were infected abroad before traveling here.

The California order was announced on the same day that New York state’s indoor public mask mandate took effect. According to NBC, similar orders have been issued in Washington, Oregon, Illinois, New Mexico, Nevada and Hawaii.

When asked whether the measure was a first step top other increased restrictions Ghaly said, “Absolutely not.

When asked about enforcement of the mandate statewide, California’s top health official acknowledged that some venues will adhere to the order more strictly than others. But, he emphasized, “We are expecting Californians to heed the warnings and mask up.”

California orders statewide mask mandate amid rise in COVID [Los Angeles Times, 13Dec 2021]

BY RONG-GONG LIN II

Faced with rising coronavirus cases, California is ordering a statewide mask mandate for indoor public spaces to go into effect on Wednesday.
The order will affect roughly half the state’s population, including San Diego and Orange counties, the Inland Empire, the Central Valley and rural Northern California. The statewide indoor mask mandate order will last a month and will expire on Jan. 15.

Los Angeles County, Ventura County and most of the San Francisco Bay Area have their own indoor mask mandates that were implemented in the summer.

The move comes as coronavirus case rates have risen by 50% in the last 2½ weeks, and county health officials across the state say they suspect they may be seeing the start of a winter jump in coronavirus cases. The U.S. Centers for Disease Control and Prevention considers California as having a high level of transmission of the coronavirus, the worst tier in the federal agency’s four-tier scale.

California is also recommending that travelers who return or visit the state get tested within three to five days of their arrival.

California’s announcement came on the same day New York enacted its own statewide mask requirement in indoor public spaces, excepting only settings where everyone inside must be vaccinated. Officials in Britain have also re-ordered an expansion of indoor mask mandates.

The new mask orders arrive as the Omicron variant of the coronavirus — discovered only last month — has spread rapidly around the globe. Britain has recorded its first death of someone infected with Omicron variant.

“Omicron will almost certainly overtake Delta and cause new waves of infection globally,” Dr. Tom Frieden, a former CDC director, tweeted. While there has been some optimism Omicron may cause less severe illness, “this will take time to figure out,” Frieden wrote.

In addition, many states elsewhere nationally have been struggling with a winter COVID-19 surge to the still-dominant Delta variant. “We see other states in the United States struggle with overwhelmed hospitals, and a high number of cases,” Dr. Mark Ghaly, the California health and human services secretary, told reporters Monday.

Ghaly said he’s concerned that hospital capacity is still pressed and challenged, particularly in San Bernardino and Riverside counties, across the Central Valley and in the eastern Sierra and the rural north. A number of hospitals throughout the state are busier than usual for this time of year, where staff are still exhausted from battling a nearly two-year-old historic pandemic, and there’s still plenty of pent-up demand for healthcare needs that were postponed during earlier parts of the pandemic.

The evidence is there that masks still make a difference, Ghaly said. The coronavirus is airborne and can also spread silently from infected, asymptomatic people.

“Even a 10% increase in indoor masking can reduce case transmission significantly,” Ghaly said. “Wearing a mask is going to be one of the most important things to help us get through this period of uncertainty.”

“This is a critical time where we have a tool that we know has worked and can work. We are proactively putting this tool of universal indoor masking in public settings in place to ensure we get through a time of joy and hope without a darker cloud of concern and despair,” Ghaly said. “Californians have done this before. And we of course believe we can do it again.”

Under the new order to go in effect on Wednesday, California is also tightening rules related to entering large events. Existing rules require patrons age 3 and older of indoor events of 1,000 or more people, or outdoor events of 10,000 or more people, to show proof of full vaccination or the results of a recent negative test.

For patrons who chose to show a recent negative test, existing rules allow them to show a test as much as 72 hours old; the new rules require patrons to show a more recent test — within two days if it’s a PCR test, whose results need to come out of a lab, or one day if it’s a rapid antigen test.

UK hikes virus alert level as omicron variant surges [ABC News, 13 Dec 2021]

The British government has raised the country’s official coronavirus threat level and warned the rapid spread of the omicron variant has pushed the U.K. into risky territory

LONDON -- The British government raised the country’s official coronavirus threat level on Sunday, warning the rapid spread of the omicron variant had pushed the U.K. into risky territory.

The chief medical officers of England, Scotland, Wales and Northern Ireland said the emergence of the highly transmissible new strain “adds additional and rapidly increasing risk to the public and health care services” at a time when COVID-19 is already widespread. They recommended raising the alert level from 3 to 4 on a 5-point scale. The top level, 5, indicates authorities think the health care system is about to be overwhelmed.

The doctors said early evidence shows omicron is spreading much faster than the currently dominant delta variant, and that vaccines offer less protection against it. British officials say omicron is likely to replace delta as the dominant strain in the U.K. within days.

“Data on severity will become clearer over the coming weeks but hospitalizations from omicron are already occurring and these are likely to increase rapidly,” they said.

Prime Minister Boris Johnson was due to make a televised statement about Britain’s coronavirus situation and the booster vaccination campaign on Sunday evening.

Concerns about the new variant led Johnson’s Conservative government to reintroduce restrictions that were lifted almost six months ago. Masks must be worn in most indoor settings, vaccine certificates must be shown to enter nightclubs and people are being urged to work from home if possible.

Many scientists say that’s unlikely to be enough, however, and are calling for tougher measures.

Johnson’s government is trying to avoid that, but aims to offer everyone 18 and over a booster shot by the end of January.

Scientists in South Africa, where omicron was first identified, say they see signs it may cause less severe disease than delta, but caution that it is too soon to be certain.

The U.K. Health Security Agency said Friday that both the AstraZeneca and Pfizer vaccines appear less effective in preventing symptomatic infections in people exposed to omicron, though preliminary data show that effectiveness appears to rise to between 70% and 75% after a third vaccine dose.

New Coronavirus News from 12 Dec 2021

To tackle Omicron, we need serious leadership [The Guardian, 12 Dec 2021]

Readers are unconvinced that the government’s plan B measures will be enough to curb Covid cases and deaths

Well said, Rachel Clarke (Talk of a No 10 Christmas party is an insult to the thousands who have died of Covid, 8 December). Her wholly justifiable anger, based on her frontline experience of caring for her patients, encapsulates, I suspect, the fury and frustrations of many.

Once he has completed his investigations into “partygate”, the cabinet secretary might usefully place a copy of Ms Clarke’s article alongside the agenda for future cabinet meetings, if only to remind participants that government is a serious business with serious consequences, ideally conducted by serious professionals rather than the current bunch of self-serving, irresponsible amateurs.
Phil Murray
Linlithgow, West Lothian

With the number of the new Omicron cases likely to rise exponentially, and stringent national measures needed, one thing is sure – the rightwing Covid recovery group of Tory MPs will vote against them (Javid advised to take ‘stringent’ Covid measures within a week, leak reveals, 10 December). Their argument will inevitably focus on the impact of such measures as masks in pubs or stricter isolation requirements on the economy, and by voting against the proposals they give yet more encouragement, as if any more was needed after the Downing Street party fiasco, to a UK public keener than ever to disobey.

I have yet to hear a counter argument that details what effect a wave of hospitalisations – up to 10,000 a day – would have on the economy (Report, 10 December). As there is very little data on the severity of disease caused by Omicron, the only sensible approach has to be preventative and cautious. Tory backbenchers might be willing to play politics with the lives of the British people, but making a new strain of a deadly virus a political football is downright despicable.

The sixth richest economy in the world can easily afford to subsidise hospitality venues in trouble, but it cannot afford risking a variant that evades the population’s built-up immunity running rife.
Bernie Evans
Liverpool

It’s ironic that just about the only sensible anti-Covid measures our prime minister is contemplating – further controls to combat the spread of the virus – are prompting the biggest rebellion so far among his backbenchers (Report, 9 December). Damned if you do, damned if you don’t.
Tom Uprichard
London

From this week, if my mates and I want to go and watch our football team we will need a Covid passport and we will need to wear a mask in the ground (Report, 8 December). We will also need to wear a mask if we use public transport to get there – but we can spend several hours in a pub beforehand, mingling and talking without any restrictions. That’s OK then.
Allan Brown
Peterborough

We used to go to the cinema about twice a month, but haven’t been now for almost two years.
The thought of sitting near an unvaccinated, unmasked person who may have pre-symptomatic Covid is a continuing deterrent. What damage to the economy are those “freedom” warriors in parliament doing if thousands of people like us won’t spend our money going out and about? We’d love to see the new West Side Story so glowingly reviewed by Peter Bradshaw, and we just might if the cinema asks for vaccine passports and masks now.
Sue Humphries
York

How Omicron appears to be infecting Britain – despite the vaccine [The Guardian, 12 Dec 2021]

By Helen Pidd

Anecdotal reports suggest mass outbreaks after social gatherings – even among people who have had a Covid booster

irst there was the party at the Oslo restaurant that resulted in 80 out of 111 guests catching Covid, mostly the Omicron variant, despite being double vaccinated and having tested negative before attending. Then came the seven German tourists who all travelled together to South Africa and caught Omicron despite having received a booster.

Over the last few days, anecdotal reports have suggested an increasing number of Omicron outbreaks at social gatherings in the UK, too. The broadcaster Victoria Derbyshire tweeted that her brother caught Covid three or four weeks after receiving his booster jab after a night out with “a load of mates” on 3 December. All were vaccinated and 17 out of 21 tested positive, she said.

Although official data has yet to confirm the trend, concerns are mounting about the impact of increased transmissibility, including among fully vaccinated people, even if most are reporting relatively mild symptoms.

“Certainly, compared to the Delta variant, we’re seeing more of these multiple infection events,” said Tim Spector, a professor of genetic epidemiology at King’s College London, who runs the Zoe Covid symptom app. “Delta didn’t seem to affect everyone at an event – just one out of six vaccinated people might get ill then.” Now, it could be a majority.

Omicron also seems to come on very quickly, “because the transmission time is very short”, said Spector. That’s why he is advising anyone attending a social gathering to do a rapid lateral flow test (LFT) “a few hours before leaving the house”, rather than relying on one from the day before or earlier.

On Sunday the education secretary, Nadim Zahawi, said there were now Omicron cases in UK hospitals and warned that the new strain was “so infectious that it will dominate and exponentially grow”.

On Friday the Zoe app launched a survey asking people to share their Omicron experiences. Early responses suggest that Omicron seems to be able to evade vaccine protection in some people, as borne out by UKHSA data released the same day. “People are saying: ‘We went to this event and nearly all of us are testing positive, and we’re waiting to find out if this is Omicron,’” said Spector.

Many people only learn they have Omicron several days after receiving a positive PCR test. That’s because not all samples are being sequenced for the variant and because only a third of labs in England are capable of telling people immediately if they have it, said Spector.

“The problem is that only about a third of the country would know immediately if it’s Omicron or not, and only a sample are being tested. So depending on where you live, the risk of having a PCR test that comes back and immediately says this is probable Omicron is going to vary, and it’s actually lower in the south and London than it is in the north of England.”

Most labs don’t yet have the technical capabilities to detect the gene “dropout” associated with Omicron, he explained, adding: “It’s not about whether it [is a] good or bad lab, it’s just what they were set up to do.”

One person contacted the Guardian to say they went on a weekend away with four friends and all four later tested positive for Covid. They had received their booster and the other three had been double jabbed.

Two days after their PCR results came back, two received a text from NHS England saying: “Following our previous guidance, we have identified that you may have the Omicron variant of Covid-19.”

The text instructed them to tell everyone in their household to self-isolate, regardless of their vaccination status or age. The person who had been boosted said: “None of us have been really ill. Me the lightest – the heaviest did a day in bed. No one has been really ill. We have all had worse colds.”

One Zoe contributor said 16 out of 18 people at a 60th birthday party in Somerset tested PCR positive for Omicron. All were vaccinated, some with boosters, and had a negative LFT 24 hours beforehand. Their symptoms were mild, Spector said: sore throats, nausea, slight temperatures and headaches. No one needed a doctor.

He said he was advising people to stay at home if they have cold-like symptoms. “Avoid large gatherings and split your groups up into smaller ones where you can control the environment and get everyone to test that day.

“Make sure that no one attending that party has cold-like symptoms, or hasn’t had cold-like symptoms the past three or four days, and on the way to the event make sure that you’re wearing a high-quality mask on crowded public transport, which people are not doing.”

Will Omicron kill Christmas? How science stacks up in boosters v Covid variant battle [The Guardian, 12 Dec 2021]

By Robin McKie

Analysis: UK faces grim winter if vaccines offer poor overall protection, but if the virus has weak powers to evade immunity, hospital cases can be contained

Two competing forces will determine Omicron’s impact on the nation over the next few weeks. The power of booster jabs to give last-minute protection against Covid-19 will be pitted against the new variant’s ability to elude existing immunity. The outcome will decide whether our festive season is going to be muted or miserable.

If enough arms are jabbed with booster vaccines, while Omicron turns out to have poor powers to evade immunity, then there is hope hospital cases will be contained and the NHS will be protected. Severe restrictions in the new year – including the prospect of lockdowns – could be avoided.

But if Omicron is found to evade existing immunity quite easily, while booster campaigns provide poor overall protection, then the country faces a very grim winter with strict restrictions needed for some time.

According to a study by scientists at the London School of Hygiene & Tropical Medicine, the first scenario – poor Omicron escape from immunity matched by effective booster jab protection – would trigger a wave of infection that could lead to 175,000 hospital admissions and 24,700 deaths by the end of April. Closure of some entertainment venues and restrictions on indoor hospitality would be enough to control case numbers.

By contrast, the most pessimistic scenario – high immune escape from vaccines and low effectiveness of booster jabs – would see 74,800 deaths while there would be 492,000 hospital admissions, a figure twice as high as the peak seen in January 2021. Far stricter restrictions, including lockdowns, would then have to be considered.

“These results suggest that Omicron has the potential to cause substantial surges in cases, hospital admissions and deaths in populations with high levels of immunity, including England,” the team state in their paper, which has not yet been peer-reviewed. Nicholas Davies, co-leader of the study team, described Omicron’s threat to the UK as “worrying”.

Presented with evidence like this, many scientists have warned that urgent action should now be taken to hold back infections while booster campaigns are accelerated and given time to take effect. “Cases are doubling every two to three days which means there is a real risk the curve is going to get very steep around Christmas and New Year,” said the vaccine expert Peter English.

“That means panic measures could be brought in at the last minute and disrupt people’s festive plans. I am also desperately sad for my colleagues in clinical practice who face a January that is going to be worse than anything we’ve seen so far and at a time when they are now exhausted.”

However, the epidemiologist Prof Mark Woolhouse, of Edinburgh University, counselled caution. “Lockdown interventions buy time, that is true, but they also cause wider harm. Other, more sustainable measures – such as wider use of self-testing – may prove to be more viable.”

The crucial point about making strict interventions was not to prevent the population getting Covid but to avoid too many people getting it at the same time, he added. “I don’t expect to live out my years without getting Covid once or twice some time in the future – and that applies to the rest of the population. Individual risks have not changed. The problem is that it looks as though an awful lot of us are going to encounter it in the next few weeks.”

Other scientists said they were slightly more optimistic. The virologist Prof Ian Jones, of Reading University, said the grimmest scenarios did not take into account the availability of new antiviral drugs that have been shown to lessen the impact of the virus if given soon after infection. “If this better clinical picture is factored in, the link between infection and severe disease may not be as high as assumed here, and the outcome not as alarming.”

This point was backed by Prof Paul Hunter, an infectious diseases expert at the University of East Anglia, who said there was evidence that Omicron was associated with less severe disease and that models overestimated hospital admissions, possibly substantially. “I suspect these models overstate risk of hospitalisation and deaths and the worst case scenarios are unlikely to be seen.”

If the dangers of Omicron turn out to be exaggerated, the prospects of further variants disrupting society cannot be ignored, said the global health researcher Michael Head, of Southampton University, who accused rich countries including the UK of hoarding vaccines instead of sending them to nations with less well-developed health services. “We don’t know how often this coronavirus can change its clothes and emerge with a new look but the risks of new variants emerging are higher in under-vaccinated populations. The coronavirus has not finished with us.”

Omicron appears to 'evade' some protection from COVID vaccines, Fauci says [New York Post, 12 Dec 2021]

By Jackie Salo

Dr. Anthony Fauci on Sunday said “sobering” preliminary studies show the Omicron variant of COVID-19 appears to evade some of the protection provided by vaccines.

But the White House chief medical adviser added that at least booster shots appear to help increase efficacy against the variant.

“The thing that’s important is that [Omicron] appears to be able to evade some of the immune protection of things like monoclonal antibodies, convalescent plasma and the antibodies that are induced by vaccines. That’s the sobering news,” Fauci told ABC anchor George Stephanopoulos on “This Week.”

“The somewhat encouraging news is that preliminary data show that when you get a booster, for example, a third shot of an mRNA, it raises the level of protection high enough that it then does do well against the Omicron,” Fauci added.

Also encouraging are reports that suggest the virus may cause less severe symptoms than the Delta variant, which has become the dominant strain, Fauci said.

“We’re getting anecdotal information … not necessarily confirmed yet, that the level of severity appears to be maybe a bit less than in the Delta. But there are a lot of confounding issues that it may be due to the underlying protection in the community due to prior infections,” Fauci said.

The World Health Organization has designated Omicron a “variant of concern” — the agency’s highest threat level — because of its unprecedented number of mutations to its spike protein, the component of the virus that binds to cells. Delta is also listed as a “variant of concern.”

Despite fears that Omicron’s mutations may make it somewhat resistant to vaccines, Fauci predicted last week that a booster specifically targeted for the variant might not be necessary.
“I’m not so sure that we’re going to have to get a variant-specific boost vaccine to get an adequate protection from Omicron,” Fauci told the health Web site STAT in an interview published Friday.

“Because if you look at protection against variants, it appears to relate to the level of immunity and the breadth of the immunity that any given vaccine can instill on you,” he said.

What Has Omicron Changed? [The New Yorker, 12 Dec 2021]

By Dhruv Khullar

Although the initial findings on the new COVID variant are encouraging, it’s important not to place too much stock in them prematurely.

The COVID-19 pandemic, like every pandemic before it, is a story of equilibriums: between viral biology and human immune response; between news of the pathogen and fear of it; between the damage it inflicts and the social, economic, and political choices we make. A disease persists as a pandemic as long as these forces remain in flux; it becomes endemic when the balance is, more or less, set. The morning after Thanksgiving, Americans awoke to an unsettling revelation: Omicron, a highly mutated version of the coronavirus, with an unprecedented number of genetic changes, had been detected in southern Africa. Since then, it has appeared in dozens of countries across six continents and in at least twenty-two states.

Our equilibrium has shifted again. But what, exactly, has changed?
An early sketch of the Omicron variant is coming into focus. It is, almost certainly, more transmissible than the Delta variant, which itself spreads more than twice as fast as the original strain. In mid-November, South Africa recorded an average of three hundred coronavirus cases a day; only about two per cent of tests returned positive. The country now routinely logs fifteen thousand cases a day, and the test-positivity rate has soared more than tenfold. But Omicron hasn’t overwhelmed the South African health-care system, even in Gauteng Province, where it first started to spread.

Earlier this month, doctors at the Steve Biko/Tshwane District Hospital Complex, a major medical center in Pretoria, released a report describing the clinical condition of COVID patients admitted during the current surge. On December 2nd, there were forty-two patients, of whom just fourteen required supportive oxygen (and not all necessarily because of the virus), and only one was admitted to the I.C.U. In recent weeks, the average length of hospitalization was three days, compared with about nine in the past; the mortality rate has been roughly a third of what it was. “I’ve never seen this picture before,” Fareed Abdullah, the report’s lead author, said. “At this stage of the beginning of the fourth wave, the main presentation is incidental COVID”—patients who came in for other reasons and happened to be carrying the virus.

Although these findings are encouraging, it’s important not to place too much stock in them. Most recent patients at the Tshwane District Hospital have been under the age of fifty—a group with a relatively low risk for severe illness, and, in South Africa, a very low immunization rate. It’s also possible that some of Omicron’s perceived “mildness” is a reflection of its immune-evasiveness: early evidence suggests that it may be nearly three times as likely as other variants to cause repeat infections. If Omicron leads to milder symptoms in people who haven’t previously been infected or vaccinated, that would be reason for comfort; if, instead, it produces illness requiring hospitalization in those who’ve survived a prior infection, that’s cause for concern.

Yet, even if Omicron does inflict less severe disease, we’re still left with a complicated picture. The damage a virus causes is the product of its virulence and its transmissibility: a small reduction in the former coupled with a sharp rise in the latter can be more devastating than the reverse. (The COVID-19 pandemic, compared with the SARS or MERS outbreak, is itself an example of such a phenomenon.) Omicron’s contagiousness could mean that it homes in on vulnerable people—the elderly, the immunocompromised, the unvaccinated—and unleashes a fresh round of misery. On the other hand, a very mild, hyper-contagious variant—the most hopeful, perhaps unrealistic scenario—might be a good thing: huge swaths of people would develop some level of immunity while facing a low risk of serious illness.

The Biden Administration has introduced several efforts designed to place the nation on a surer footing this winter. It has implemented restrictions on travel from a number of countries in southern Africa—which may allow a few extra days or weeks to prepare—and will require all international travellers to present proof of a negative test taken within a day of departing for the United States. It has also extended mask mandates on buses, trains, and planes, which were due to expire in January, and plans to set up hundreds of additional vaccination sites around the country. In the meantime, the U.S. has purchased millions of courses of antiviral pills from Merck and Pfizer; the Food and Drug Administration is expected to authorize their use later this month. The F.D.A. has also indicated that it will fast-track the authorization of Omicron-specific vaccines, which could be ready in March.

By then, however, Omicron will, in all likelihood, have displaced Delta as the dominant variant in much of the world, including here, and a central concern has been that its abundant mutations will render current vaccines ineffective. Indeed, some studies suggest that two doses of the Pfizer vaccine produce dramatically fewer antibodies against Omicron than they did against previous variants. But antibodies are only one part of the immune system. They specialize in preventing infection, while T cells, which appear undiminished in the face of Omicron, focus on terminating it. This could mean that, though Omicron may cause many more breakthrough infections, vaccines will still help our immune systems avert serious illness. (Breakthrough infections were already on the rise, but, for the most part, they remain comparatively mild.)

And that’s before a booster shot. Last week, Pfizer announced that a third shot of its vaccine produces a level of protection against Omicron comparable to that against previous variants.
This finding is consistent with a study from South Africa, which found that the antibodies of people who’d been fully vaccinated and had a prior infection remained robust against the new variant. Being “fully vaccinated” may now require two shots plus a booster. It’s regrettable, then, that while the emergence of Omicron has sparked a surge in vaccinations in this country, just sixty per cent of Americans are immunized, and only a quarter of adults have received a booster.

Omicron is poised to take off just as the nation confronts a new Delta wave. More than fifty-five thousand people are currently hospitalized with COVID-19, and there are more than a hundred and twenty thousand recorded new cases a day—both substantial increases since Thanksgiving. The federal government is sending health-care workers to support overwhelmed hospitals in Michigan; the governors of Maine and New York have deployed the National Guard to provide assistance. There may still be time to shift the new equilibrium in our favor—to compress the pandemic and start the endemic. But that time is running out.